Rationale for extent of operation choice in rectal cancer
Keywordsrectal cancer, sentinel lymph node, Indocyanine Green, transanal endoscopic microsurgery
Introduction. Colorectal cancer (CRC) remains relevant occupying one of the leading places in morbidity and mortality among oncological diseases. It reaches 13.5% in the structure of tumor diseases tending to increase.
The aim of the work to improve the choice of surgical treatment management and reduce the number of intraoperative and postoperative complications in rectal cancer patients.
Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: 1 group (patients with stage I RC (T1-2N0M0) and 2 group (stage II RC (T3N0M0)) who were carried out intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS). The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and distant (recurrence of rectal cancer) complications.
Results. The patients of the 1 group had no MTS lesions of sentinel lymph nodes, due to this fact the surgical intervention was limited to transanal microsurgery. Among the complications were the following: bleeding – 2.2%; intraoperative perforation of the intestinal wall – 5.6%. No purulent-septic cases, no recurrences of rectal cancer were detected. In group 2, of 94 patients, 36 (38.3%) had MTS detected intraoperatively in sentinel lymph nodes which required a low anterior rectal resection with total mesorectomectomy. Among the complications was bleeding – 6.3%. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (13.8%) patients.
Conclusions. Performing transanal endoscopic resections in patients with RC I and especially stage II is possible only under the conditions of mandatory intraoperative staining and emergency histological examination of "sentinel" lymph nodes. The extent of surgical intervention is determined on the operating table based on the results of an emergency histological examination. When MTS lesions of the mesorectal "sentinel lymph nodes" are detected, the operation should be continued with mandatory mesorectomectomy.
Grubnik VV, Nikitenko RP, Degtyarenko SP, & Grubnik VV. Transanal endoscopic operations in rectal tumors. Klinicheskaia Khirurgiia. 2019; 86(3): 15-18. doi.org/10.26779/2522-1396.2019.03.15.
Konishi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Akiyoshi T, Yoshimatsu H, Watanabe T, Yamaguchi T, Muto T. Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surg Endosc. 2011; 25: 2358-2359 DOI:10.1007/s00464-010-1531-y.
Quadros CA, Falcao MF, Carvalho ME, Ladeia PA, Lopes A. Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. J Surg Oncol. 2012; 106: 653-8. https://doi.org/10.1002/jso.23144.
Lezoche E, Baldarelli M, Lezoche G, Paganini AM, Gesuita R, Guerrieri M. Randomized clinical trial of endoluminal locorregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg. 2012; 99: 1211-1218. doi.org/10.1002/bjs.8821.
Morino M, Risio M, Bach S, Beets-tan R, Bujko K, Panis Y, Quirke P, Rembacken B, Rullier E, Saito Y, Youngfadok T, Allaix ME. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc. 2015; 29: 755-73. DOI: 10.1007/s00464-015-4067-3.
Bilhim T, Pereira JA, Tinto HR, Fernandes L, Duarte M, O'Neill JE, et al. Middle rectal artery: Myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat [Internet]. 2013; 35: 517-522. DOI: 10.1007/s00276-012-1068-y.
Ermakov V, Saribekyan EK, Ablitsova NV, Usov FN. Sentinel lymph nodes in malignant tumors Malignant Tumors. 2017; 1(22): 70-7. DOI:10.18027/2224-5057-2017-1-70-77
Allaix ME, Arezzo A, Arolfo S, Caldart M, Rebecchi F, Morino M. Transanal endoscopic microsurgery for rectal neoplasms. How do I do it. J Gastrointest Surg. 2013; 17: 586-592. DOI: 10.1007/s11605-012-2060-x
Wu Y1, Wu YY, Li S, Zhu BS, Zhao K, Yang XD, et al. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepato- gastroenterology. 01 Mar 2011; 58 (106): 364-368. PMID: 21661397
Denzer U, Beilenhoff U, Eickhoff A, et al. S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021–022. ZGastroenterol. 2016; 53: E1-E227. doi.org/10.1055/s-0041-109598
Mölle B, Ommer A, Lange J, Girona J (eds.). Chirurgische Proctologie. Springer, Heidelberg, Berlin, New York, 2018. 478 p. https://doi.org/10.1007/978-3-662-54682-6.
Schmidt A, Bauerfeind P, Gubler C, et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy. 2015; 47: 719-725. https://doi.org/10.1055/s-0034-1391781.
Watanabe T, Muro K, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018; 23: 1-34. doi.org/10.1007/s10147-017-1101-6.
Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg. 2019; 269 (4): 596-602.
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017; 266(1): 111–7.
Smith JJ, Strombom P, Chow OS, Roxburgh CS, Lynn P, Eaton A, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy. JAMA Oncol. 2019; 5: e 185896.
How to Cite
Copyright (c) 2021 R. Nikitenko, V. Kosovan, K. Vorotyntseva, E. Koichev
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 57
Number of citations: 0